quality, integrated and evidence-based care.

That's why RNAO’s LTC Best Practices

Program (BPP) focuses on supporting LTCHs to

achieve these goals by providing expertise and

a systematic approach to using best practice

guidelines (BPG).

The LTC Best Practice Spotlight Organization®

(LTC-BPSO) program is designed to address

the unique requirements of LTCHs, and to

provide tailored supports to ensure their

successful engagement in the three year pre-

designation period and beyond. In this edition

of the Best Practices in Long-Term Care

newsletter, we shine the spotlight on the two

organizations selected in the second cohort of

LTC-BPSOs®, Pioneer Ridge Home for the

Aged in Thunder Bay and Saint-Louis

Residence, Bruyère Continuing Care in Ottawa.

Representatives from these homes came

together with other BPSO organizations in

March to launch their journey, which begins with

the 2015-2018 pre-qualifying period. We also

catch up with the four LTC organizations in the

first cohort that now have more than a year of

experience as LTC-BPSOs®.

This edition of the newsletter features an

interview with RNAO Program Manager Althea

Stewart-Pyne, who discusses the healthy work

environment BPG, Developing and Sustaining

Interprofessional Health Care. The guideline

contains recommendations and supporting

www.RNAO.ca/ltc | p1

Best Practices in Long-Term Care

Working together towards excellence in resident care.

Suman Iqbal, RN, MSN/MHA Long-Term Care Best Practice Co-ordinator, Provincial Projects

Learn more about the LTC-BPSOs on pages 2 and 3

evidence to help LTCHs and interprofessional

teams work collectively to provide

comprehensive, quality health services to

residents. A Tips and Tools guide based on the

BPG details how to plan, provide, develop and

sustain interprofessional health care in your

work environment.

RNAO's Caregiving Strategies for Older Adults

with Delirium, Dementia and Depression BPG is

frequently consulted by LTCHs for strategies to

manage responsive behaviours. To support

LTCH staff in improving documentation of these

behaviours, an RNAO LTC best practice co-

ordinator explains how she collaborated with

community partners and used best practices,

relevant professional practice standards, LTC

legislation, and prevailing practices in dementia

care to develop a framework to guide effective

documentation.

A special collection of tools and resources for

health-care providers and organizations striving

to prevent and address the abuse and neglect

of older adults, the Best Practice Success Kit, is

now available. Read about the resources

contained in the kit and how they can be used

to improve your practice.

In the spring, the LTC BPP conducted a survey

of Ontario LTCHs about how they use RNAO

and other provincial resources, the impact of

RNAO BPGs on clinical practice and resident

outcomes in LTCHs, and the supports they

need to implement sustainable evidence-based

practices. Accompanying this newsletter is a

summary of the survey results and how we plan

to use them to foster evidence-based practices

in LTCHs. Thank you to all who responded to

the survey. The LTC BPP looks forward to

supporting the use of best practices in your

LTCH.

Supports for Implementing Best Practice Guidelines

Carol Holmes, RN, MN, GNC(C), Program Manager, LTC Best

Practices Program

We all know that

practice change and

using the best evidence

do not happen easily.

Long-term care home

(LTCH) leaders and

point-of-care staff strive

to provide safe, high-

The LTC-BPSO® program began in 2014 to provide

LTCHs the opportunity to partner with the Registered

Nurses’ Association of Ontario (RNAO) to create

evidence-based cultures in their organizations through

the systematic implementation of multiple RNAO

BPGs.

Welcome to the newest LTC-BPSOs® for

2015-2018 In March 2015, RNAO launched cohort B of the LTC-

BPSO® designation for the 2015-2018 period.

Thunder Bay's Pioneer Ridge Home for the Aged and

Bruyère Continuing Care’s Saint-Louis Residence in

Ottawa were welcomed into the program at a launch

event by Denise Cole, Assistant Deputy Minister,

Health Human Resources Strategy Division, on behalf

of the Minister of Health and Long-Term Care.

RNAO’s Chief Executive Officer, Doris Grinspun

shared her vision for BPSO® designation, and

detailed the impact nurses are having on clinical

outcomes through the promotion and implementation

of evidence-based practices. At the launch event,

representatives from the incoming organizations

heard about highlights and achievements from the

2014-2017 cohort of LTC homes. They also met and

clarified the expectations of this initiative, identified

key milestones, and prepared for guideline

implementation and evaluation.

Long-Term Care Best Practice Spotlight Organization®

Summer 2015, Electronic Edition

IN THIS ISSUE

2 – 3 Update on LTC-BPSOs 4 Developing and Sustaining

Interprofessional Health Care 4 LTC Best Practices Toolkit 5 – 6 Best Practices in Documenting

Responsive Behaviours 6 Best Practice Success Kit for

Addressing Abuse in Older Adults

7 – 8 Highlights of the 2015 Provincial Survey

9 Announcements

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p2

Saint-Louis Residence (SLR) is part of Bruyère Continuing Care, a large

consortium that provides sub-acute and primary care services and

operates two LTCHs. Bruyère Continuing Care is spread over three sites:

1. St. Vincent's – complex continuing care 2. Élisabeth Bruyère Hospital – palliative and rehabilitation care, and

care for the elderly at Residence Élisabeth Bruyère 3. SLR – a francophone LTCH with Ontario's first designated

specialized unit for peritoneal dialysis

Bruyère Continuing Care was founded in 1845 when Mother Élisabeth

Bruyère and three sisters arrived in Ottawa and opened a general hospital

and the first bilingual school in Ontario. Today SLR is located on the

Ottawa River in Orleans.

Number of residents: 198

Number of staff: 360

Special features: SLR is a francophone-designated LTC home with a

specialized unit for peritoneal dialysis, respite and convalescent short stay

services.

BPGs selected for implementation: SLR will start by implementing the

Prevention of Falls and Fall Injuries in Older Adults and Oral Health:

Nursing Assessment and Interventions BPGs. In the second year, the

Promoting Continence Using Prompted Voiding and Risk Assessment and

Prevention of Pressure Ulcers BPGs will be implemented.

LTC-BPSO Liaison: Teresa Lee, Clinical Manager, Élisabeth Bruyère

Résidence/Advanced Practice Nurse Long-Term Care

LTC-BPSO Coach: Ibo MacDonald, LTC Best Practice Co-ordinator,

Champlain

The goal for SLR in becoming a LTC BPSO® designate is to optimize

clinical excellence. SLR firmly believes the opportunity to work with RNAO

in implementing clinical practice guidelines will be of great benefit to

residents, staff and the Ontario LTC sector. The home officially launched its

BPSO® journey during Nursing Week on May 15 which coincided with the

170th anniversary of Bruyère Continuing Care.

Pioneer Ridge is an accredited municipal LTCH operated by the City of

Thunder Bay and is located in the heart of beautiful northwestern

Ontario.

Number of residents: 150

Number of staff: 191

Special features: The name of the home reflects respect for the

founders of the city. It honours the people who had the strength of

character and the commitment to build a home for their families and

carve a livelihood from the land.

BPGs selected for implementation: The following three BPGs have

been selected for implementation: Preventing and Addressing Abuse

and Neglect of Older Adults; Oral Health: Nursing Assessment and

Interventions and Strengthening and Supporting Families through

Expected and Unexpected Life Events.

LTC BPSO Liaison: Liane Heebner, Best Practice Clinician

LTC BPSO Coach: Heather Woodbeck, LTC Best Practice Co-ordinator,

North West

Pioneer Ridge has selected these BPGs based on feedback from the

Senior Management Committee, the Total Quality Management Team,

the Quality Practice Committee, the nursing team, as well as residents

and their families. The decision was also based on existing data that

clearly identified areas for improvement. Pioneer Ridge began

implementing the Preventing and Addressing Abuse and Neglect of

Older Adults BPG in April 2015 across the entire home, which consists

of four resident care units. In the second year, the organization plans to

implement two BPGs: Oral Health: Nursing Assessment and

Interventions and Supporting and Strengthening Families through

Expected and Unexpected Life Events.

To facilitate the implementation of the selected BPGs, Pioneer Ridge will

utilize its existing Quality Practice Committee as the BPSO® steering

committee, with existing clinical committees focusing on the

implementation of each individual BPG. By utilizing existing committees

in this process, there are additional opportunities to grow and create

further improvement initiatives by implementing more guidelines. Pioneer

Ridge is looking forward to continuing implementation of RNAO’s BPGs

to improve resident, nursing and organizational outcomes.

Bruyère Continuing Care’s Saint-Louis

Residence Pioneer Ridge Home for the Aged

...LTC-BPSO® (continued)

Left to right: Traci Fisher-Zaizer

(Director of Nursing), Lee Mesic

(Administrator), Tanya Baker

(Education Co-ordinator), Liane

Heebner (BPSO Lead, Best

Practice Clinician), Sheila

Hansen (Associate Director of

Nursing)

Left to right: Teresa

Lee (BPSO Lead,

Manager/APN), Simon

Akinsulie (Executive

Director), Ibo

MacDonald (RNAO

LTC BPC, Champlain)

The journey so far...LTC-BPSO® cohort for

2014-2017

The 2014-2017 LTC-BPSO® cohort includes: Parkview Manor Health Care

Centre, Chesley; Region of Peel's Long-Term Care Division (Sheridan Villa,

Peel Manor, Malton Village, Tall Pines, and The Davis Centre); St. Peter’s

Residence at Chedoke, Hamilton; and Vision Nursing and Rest Home,

Sarnia. Over the past year, these LTC homes have implemented one or

more RNAO BPGs, and supported their staff to participate in the Best

Practice Champions Network® and attend the Clinical Best Practice Guideline

Summer Institute.

These LTCHs are actively engaged in implementing, monitoring, and

evaluating BPGs and submitting data on nursing practice, resident and

organizational indicators at regular post-implementation intervals. Staff and

leaders from the homes actively share their experiences with the health-care

community through the RNAO website, at RNAO events, by mentoring other

LTCHs, and presenting at local events and conferences.

Parkview Manor Health Care Centre Parkview Manor’s first year has been very successful and inspiring. The

organization has spent the year developing a culture of care that embraces

best practices. This part of the journey alone was a big venture, as change is

not easy for many people. BPGs implemented so far are:

Client Centred Care: Tools were created to understand the resident as a person and a survey was conducted to track data for quality improvement.

Preventing and Addressing Abuse and Neglect of the Older Adult: The organization created educational packages including video vignettes on abuse and neglect of older adults. The five vignettes are supported by a facilitator’s guide and are available at RNAO.ca/elder-abuse for all to use.

“The most rewarding part of the journey for me as a nurse is breaking down the barriers between LTCHs and working together towards a common goal of improving lives of those we serve. The partnerships that are developing are very important and will continue long after our pre-designation period is complete,” says Teresa Tibbo, the LTC-BPSO® Liaison for Parkview Manor.

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p3

Region of Peel – Long-Term Care Division The first year in Peel Long-Term Care’s journey to become an LTC-BPSO®

involved building awareness among staff members at its five LTCHs and

implementing the Assessment and Management of Pain BPG within the

Special Behavioural Support Unit (SBSU) at Sheridan Villa.

A new electronic tool for screening and a comprehensive assessment tool to

improve pain management for cognitively impaired residents were

introduced. In the second year, the Region of Peel is focusing on sustaining

and evaluating the practice changes made in the SBSU and systematicly

rolling out the Prevention of Falls and Fall Injuries in Older Adults guideline

across all five homes.

Peel LTC recognizes the contributions the BPSO® program is making to its

continuous quality improvement journey by promoting a culture of evidence-

based practice.

St. Peter’s Residence at Chedoke

The biggest achievement to date at St. Peter's has been a culture shift. Staff are now constantly questioning the processes and practices, asking if they are using "the best way.” This shows an understanding and appreciation of evidence-based best practice. St. Peter’s is implementing the following BPGs:

Client Centered Care: Initiatives are focused on supporting residents to direct their own care. St. Peter's is reviewing and revising policies and procedures regarding consent and capacity and advanced care planning.

Preventing and Addressing Abuse and Neglect of Older Adults: St. Peter's is enhancing the admission process and quality of communication related to abuse.

Developing and Sustaining Nursing Leadership: Point-of-care nurses are taking leadership on initiatives in the home including committee work, a mentorship program and BPSO® champions.

Through involvement as a LTC-BPSO®, St. Peter’s has seen its mission, vision and values come to life as it continues to build, support and maintain a culture of evidence-based practice.

Vision Nursing and Rest Home Kathleen Waller, the LTC-BPSO® Liaison for Vision Nursing Home, says the home's

BPSO® journey thus far has been exciting and challenging, as well as very rewarding

for everyone at Vision. In 2014, Vision implemented the Prevention of Falls and Fall

Injuries in Older Adults BPG across the home and the organization is ecstatic to say

that they have decreased and sustained the number of falls by an average of 50 per

cent. For 2015, staff is focusing on the Client Centered Care BPG and will move on to

the Delirium, Dementia and Depression BPG the following year. Despite the

challenges, Vision has seen marked improvement to quality of life for its residents,

and is looking forward to continuing to implement other BPGs as they move

forward in their journey.

Amy: According to the guideline, what is interprofessional care? Why is it important, and how does it differ from collaborative practice? Althea: The definition of interprofessional care used in the guideline is: "the provision of comprehensive health services to patients/clients by multiple health caregivers who work collaboratively to deliver quality care within and across settings". Interprofessional care is crucial for all health professionals to work to their full scope of practice, regardless of the health-care setting. Interprofessional care has been shown to enhance outcomes for patients, clients and residents, reduce costs, and improve the work environment. Interprofessional care guides health-care professionals in collaborative

Althea Stewart-Pyne

RN, BN, MHSc

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p4

Amy Reid, RN, Long-Term Care Best Practice Co-ordinator, North Simcoe Muskoka Althea Stewart-Pyne

RN, BN, MHSc

Suman Iqbal, RN, MSN/MHA, Long-Term Care Best Practice Co-ordinator, Provincial Projects

practice, which is a part of the fabric of interprofessional care and the two cannot be separated. The guideline provides recommendations not just to nurses, but to all members of the interprofessional team, including physicians, pharmacists, occupational therapists, etc. In contrast, RNAO’s Collaborative Practice Among Nursing Teams BPG speaks specifically to nurses – including nurse practitioners, registered nurses, and registered practical nurses – as intra-professionals who bring similar educational foundations but differ in the depth and breadth of their professional knowledge and skills. Amy: What professions and health-care sectors did the expert panel represent? Althea: The expert panel was comprised of professionals and students working from the bedside to the boardroom, including representatives from the fields of medicine, nursing, academia, social work, pharmacy, and occupational therapy. These experts represented various health settings, including LTC, acute care, community, and public health. Amy: How will this BPG support LTCHs to enhance interprofessional care? Althea: It will do so by providing recommendations that are applicable in any setting. The guiding principles of interprofessional care are an integral part of care delivery. The guideline discusses topics relevant to all team members such as power-sharing, decision- making, competent communication and understanding scope of practice. These are

topics that will assist any team member who works with other professionals, regardless of the sector. Amy: What resources are available to support the implementation of the BPG? Althea: The RNAO Toolkit: Implementation of Best Practice Guidelines, 2nd. Ed. is the best resource. It provides a systematic, step-by-step approach to guideline implementation and should be used with all RNAO guidelines, both clinical and HWE. In addition to that, a Tips and Tools guide is available both online and in hard copy to support implementation of the BPG. It explains interprofessional care, why it’s important, and contains tips for individual professionals and teams to develop and support interprofessional care. A self-assessment tool is included for individuals to reflect on areas of strength in collaborative practice and identify areas that need further development. The LTC Best Practice Program thanks Althea for providing information about this BPG. The BPG is available free for download from

RNAO's website:

http://RNAO.ca/bpg/guidelines/interprofessional-

team-work-healthcare

If you have any questions about the Developing and Sustaining Interprofessional Health Care: Optimizing Patient, Organizational and System Outcomes BPG or any of the other resources available please contact your local LTC Best Practice Co-ordinator.

Developing and Sustaining Interprofessional Health Care

The Long-Term Care Best Practices

Program speaks with Althea Stewart-

Pyne about the BPG Developing and

Sustaining Interprofessional Health Care:

Optimizing patient, organizational and

system outcomes. Althea is a program

manager with RNAO’s International

Affairs and Best Practice Guidelines

Centre. In this role, she leads the

development, dissemination and revision

of the healthy work environment (HWE)

BPGs.

The LTC Best Practices Toolkit is a collection of

resources and tools to assist LTC homes with the

implementation of select RNAO BPGs. Since it was

initially developed in 2008, there have been

tremendous changes in LTC and the availability of

resources and tools has increased. Therefore, the

LTC Best Practices Program team is launching a

second edition of the LTC Toolkit in the fall of 2015.

Long-Term Care Best Practices Toolkit, Second Edition

The LTC Toolkit, second edition is designed to help

LTC homes use relevant provincial legislation,

performance improvement, and other health-care

initiatives to integrate BPGs and enhance the

quality of resident care. The best practices covered

in the toolkit were identified as key areas of

concern by LTC homes in provincial surveys

conducted in 2008 and 2011.

The LTC Toolkit, second edition will provide

leaders and point-of-care staff with resources and

tools that reflect applicable legislation, regulatory

requirements, are evidence-based and consistent

with the BPG recommendations. The LTC Toolkit,

second edition is a dynamic resource, watch for

upcoming announcements regarding the launch!

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p5

Marilyn Irwin, RN, BScN, MScN, BEd, Long-Term Care Best Practice Co-ordinator, Central West

Best Practices in Documenting Responsive Behaviours

As noted in RNAO's BPG Caregiving Strategies

for Older Adults with Delirium, Dementia and

Depression, behaviours are one way that

cognitively impaired residents communicate their

unmet needs (physiological, emotional,

psychological, social and/or environmental). It is

therefore incumbent upon nurses and other care

providers to observe the context in which resident

behaviours occur, note which interventions are

effective or ineffective, and communicate this

information to encourage interprofessional

continuity and consistency of care.

According to two psychogeriatric resource

consultants (PRC) in the Central West LHIN, poor

documentation is one of the greatest barriers to

safe, effective and individualized care for

residents with dementia. LTC staff members

were often not documenting behaviours, and

when they did, their descriptions included vague

or inappropriate notations such as "aggressive

+++" and lacked the specific information required

to identify effective care strategies. The PRCs

sought support from the RNAO LTC best practice

co-ordinator (BPC) to address this issue. Using

evidence-based best practices, relevant

professional practice standards, LTC legislation,

and prevailing practices in dementia care, the

BPC designed a response. It included providing

education using practical application exercises

such as practice charting using actual scenarios

followed by feedback and discussion.

Documentation is most effective and legally defensible when it gives the reader an accurate, clear, and comprehensive picture of the: • resident’s needs and/or the context in which

the behaviour occurred; • actions or interventions that were used to

respond to these needs; and, • the outcomes or effectiveness of those

interventions, including both successful and unsuccessful strategies.

Ontario Regulation 79/10 under the Long-Term Care Homes Act, 2007, states that in caring for residents with responsive behaviours, all LTC homes shall ensure that: • there are written approaches to care; • behavioural triggers are identified (when

possible); • strategies/interventions [...] to prevent,

minimize or respond to responsive behaviours are documented; and,

• there are monitoring, reporting and referral protocols in place.

The most common reasons cited by LTC staff for failing to document responsive behaviours consistently include: • it "takes too long" or "I don't have enough

time" to chart behaviours; and/or, • the resident "always does that" or it is their

"usual" behaviour (i.e. the behaviour has been normalized over time and/or subtle escalations are not noted).

To address the gap identified by the PRCs, staff members were provided with a framework (see Figure 1 on page 6) to help them document responsive behaviours and interventions in an effective and efficient manner, providing answers to the following questions: • What triggered the behaviour (if known)? • What was the situation? (i.e. what was

going on when the behaviour occurred) • What was the behaviour? (i.e. the

resident’s response to the trigger/situation) • What interventions were used? (i.e. both

unsuccessful and successful) • What was the outcome for the resident?

(i.e. the resident’s response to the interventions).

A few other tips to improve the documentation of responsive behaviours included: • Avoid using non-specific terms like

“aggressive++," “responsive++” or “resistive++." Use very specific verbs such as pacing, swearing, spitting, hitting, disrobing, kicking, etc., to provide a more precise description of the behaviour

– especially for those who are unfamiliar with the resident. Specific language can also help staff to anticipate certain responsive behaviours and plan approaches accordingly. • When administering PRN medications as a

part of a behavioural management plan, it is not only important to document when the medication is given, but also:

o the reason for administering the drug (i.e. the triggering behaviour or situation); and,

o the effect of the medication. • When it is appropriate, save time by using

evidence-based tools or flow sheets to make charting efficient and effective. Some examples include:

o Dementia Observation System (DOS)

o Cohen-Mansfield Agitation Inventory (also consider keeping a copy of this form in charting areas as a reminder of words or phrases that effectively describe responsive behaviours)

o Individualized Dysfunctional Behaviour Rating Instrument (IDBRI)

o Pain Assessment in Advanced Dementia (PAINAD).

Sharing specific and succinct information about a resident’s responsive behaviours, including successful ways staff has responded to them, can not only improve the quality of life for residents with dementia, but also the quality of life for other residents who share their home and the staff who work with them.

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p6

Figure 1: Documentation of Responsive Behaviours

Trigger: What was the “trigger” that caused or resulted in the resident’s behaviour/response? (if known)

Situation: What was the “situation” that caused or contributed to the resident’s behaviour/response?

Behaviour: Describe the behaviour. Use specific verbs (e.g. pacing, swearing, kicking, disrobing, etc.), rather

than non-specific terms such as “aggressive,” “responsive” or “resistive."

Intervention: What interventions did you use? Include both unsuccessful and successful interventions.

Outcome: Describe the outcome (i.e. the resident’s response to the intervention).

RNAO is excited to present a special collection of tools and resources for health-care providers and organizations striving to prevent and address the abuse and neglect of older adults. The Best Practice Success Kit speaks to the specific needs of those interacting with older adults, either in a direct care role, or in a managerial or policy development role within health-care settings - including LTC. The kit is based on Preventing and Addressing Abuse and Neglect of Older Adults, Canada's first evidence-based BPG on elder abuse, funded by the Government of Canada’s New Horizons for Seniors Program.

Tools with purpose!

o The kit contains the following tools for nurses and other health-care providers:

a handy brochure: 10 Strategies to Help Health-Care Providers Address Abuse and Neglect of Older Adults

a comprehensive eLearning course in four modules with a knowledge check quiz, available in English and French (Module 1 covers introductory material suitable for anyone working with older adults)

a taking action toolkit (including examples about elder abuse and templates) to help advocate for change in your workplace

a pocket guide with key messages from the guideline

learning videos depicting some of the more subtle forms of abuse and neglect that could take place within a LTCH, and a discussion guide for reflective practice

o For organizations, an assessment tool, How Does Your Elder Abuse Prevention Program Measure Up? helps benchmark and identify areas for improvement from the BPG and a poster with a powerful message promoting these resources

o For older adults, a Health Education Fact Sheet (to be used within organizations that are adopting the BPG)

All of these resources are accessible online at www.RNAO.ca/elder-abuse

Best Practice Success Kit for Addressing Abuse in Older Adults:

Resources You Don’t Want to Miss Verity White, Project Co-ordinator, International Affairs and Best Practice Guidelines Centre

... Best Practices in Documenting Responsive Behaviours (continued)

The LTC Toolkit, which supports the

implementation of BPGs, has been used in

conjunction with capacity building resources and

events such as the Best Practice Champions

Network, Nursing Orientation e-Resource for LTC

and RNAO institutes and workshops.

The top three benefits cited from using RNAO

resources included improved staff knowledge

(88.7 per cent), improved resident outcomes

(66.7 per cent), and BPG implementation (60 per

cent). Other benefits identified were support in

using evidence-based practices (59.5 per cent),

preparation for LTCH quality inspections (41.5

per cent) and support in responding to LTCH

quality inspection findings (37.9 per cent).

RNAO resources used to support the use of

best practices: Of the 23 RNAO resources

listed, the LTC Best Practice Toolkit (LTC Toolkit)

was the most often used resource among

LTCHs, with 65.5 per cent of respondents

reporting they had utilized the toolkit. Other

resources used by LTCHs were events led by the

LTC best practice co-ordinator (BPC) (64.5 per

cent), support from the LTC BPC (53.8 per cent),

BPG fact sheets (43.7 per cent), RNAO e-

learning programs (38.1 per cent), the Best

Practices in LTC Newsletter (34.5 per cent), and

communities of practice led or facilitated by the

LTC BPC (33 per cent).

The results of the 2015 survey reinforced how

successful the LTC BPP has been in responding

to the needs of LTCHs by addressing the clinical

and work environment concerns identified in the

provincial surveys conducted in 2008 and 2011.

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p7

RNAO's Long-Term Care Best Practices Program

conducted a survey of Ontario long-term care

homes in 2015. The survey was conducted online

over a one-month period and asked questions

about how LTCHs use RNAO and other

provincial resources, the impact of RNAO BPGs

on clinical practice and resident outcomes, the

supports needed by LTCHs to implement

sustainable evidence-based practices, and other

relevant topics.

Response: Participation in the survey was

voluntary and LTCHs were asked to fill out just

one survey per home. Of the 632 LTCHs in

Ontario, 199 LTCHs responded to the survey for

a response rate of 31 per cent. The survey was

largely completed by the LTCHs' directors of

care, followed by administrators and leaders in

other clinical and management roles. The

majority of respondents had been in their role for

two years or less.

Response rate by Local Health Integration

Network (LHIN):

LHIN Total # LTCHs

# of Responses

LHIN Response

Rate

LHIN 1 37 16 43 %

LHIN 2 80 26 32 %

LHIN 3 35 11 31 %

LHIN 4 86 25 29 %

LHIN 5 23 9 39 %

LHIN 6 28 19 68 %

LHIN 7 36 9 25 %

LHIN 8 46 14 30 %

LHIN 9 69 12 17 %

LHIN 10 36 16 44 %

LHIN 11 60 11 18 %

LHIN 12 26 9 35 %

LHIN 13 49 20 41 %

LHIN 14 21 2 10 %

SPECIAL FEATURE:

Highlights of the 2015 Provincial Survey

88.70%

66.70%

60.00%

59.50% 41.50%

41.00%

37.90%

36.40%

35.40% 32.30%

Improved staff knowledge

Improved resident outcomes

Best Practice Guideline implementation Support in using evidence-based practices Support to prepare for LTC Home Quality Inspections Support for Accreditation

Support in responding to LTC Home Quality Inspection findings Support to achieve organizational priorities Annual program evaluation

Reported Benefits of Using the RNAO Resources

Reasons identified for using the top five clinical

BPGs include: quality improvement, resident

needs, preparation for the LTCH quality

inspection, meeting organizational priorities, and

responding to the findings from the inspection.

Similarly, the HWE BPGs were used to improve

staff satisfaction, quality improvement,

recruitment and retention, preparation for the

LTCH quality inspection, and to meet

organizational priorities.

Additional resources from the LTC Best

Practices Program: To further support LTCHs in

using and sustaining evidence-based practices,

survey respondents suggested the following

approaches:

Integrating BPGs to meet LTCHs Act

requirements (35.3 per cent)

Incorporating BPGs into policies and

procedures (31.8 per cent)

Program evaluation and sustainability (28.3

per cent)

Consultation with the LTC BPC (24.7 per

cent)

Knowledge exchange forums (23 per cent)

How will the LTC Best Practices Program use

the survey results?

The LTC BPP plans to address the survey results

through the following key activities from 2015-

2018:

Launch a second edition of the LTC Toolkit in

the fall of 2015.

o The topic on pressure ulcers will be

expanded to include skin and wound

care by adding additional BPGs and

resources to support this required

program.

o The topic on client centred care will

shift focus to person- and family-

centred care, consistent with the new

RNAO BPG.

o New clinical topics will be added

including the prevention of abuse

and neglect and alternatives to the

use of restraints.

o Two HWE topics will be added:

developing and sustaining nursing

leadership and prevention and

management of violence in the

workplace.

o Resources on program planning,

implementation, evaluation and

sustainability will be added to

support activities to meet LTCH

program requirements.

o A monthly webinar series will begin

with the launch of the second edition

of the LTC Toolkit focusing on each

topic and related resources.

Compile resources within the second edition

of the LTC Toolkit for other identified

priorities. A topic on care transitions will be

added in the future to support the LTCH plan

of care program. Additional topics to address

concerns related to developing and

sustaining a HWE will also be added.

Update the Nursing Orientation e-Resource

for LTC to ensure resources and tools are

current.

Promote the Best Practice Champions

workshops and webinar series.

Provide the League of Excellence for LTC to

support nurse leaders in gaining knowledge

related to integrating evidence from BPGs

into LTCH programs, and program evaluation

and sustainability.

Disseminate information about the LTC-

BPSO program, requirements and the

application process.

Continue to provide funding support, through

an application process, for LTCH staff to

attend RNAO learning institutes.

Best Practices in Long-Term Care

www.RNAO.ca/ltc | p8

Clinical and healthy work environment

priorities: Of the top three clinical concerns

identified by respondents, two were related to

required programs: falls prevention and

management (67.3 per cent) and pain

management (26.1 per cent).

Responsive behaviours were also identified as a

significant concern (63.8%). Other clinical

concerns included skin and wound care, oral

care, continence, mental health and addictions,

client-centred care, end-of-life care, and consent

and capacity.

Use of clinical and healthy work

environments BPGs: The following table

summarizes the top five clinical and HWE BPGs

used by LTCHs responding to the survey:

Top 5 Clinical BPGs used by LTCHs

Prevention of Falls and Fall Injuries in the

Older Adult

Risk Assessment and Prevention of

Pressure Ulcers

Assessment and Management of Stage I

to IV Pressure Ulcers

Promoting Continence Using Prompted

Voiding

Assessment and Management of Pain 3rd

ed.

Top 5 HWE BPGs used by LTCHs Preventing and Managing Violence in the

Workplace

Developing and Sustaining Nursing

Leadership

Professionalism in Nursing

Embracing Cultural Diversity in Health

Care: Developing Cultural

Competence

Collaborative Practice Among Nursing

Teams

CLINICAL: •Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) •Adult Asthma Care Guidelines for Nurses •Promoting Safety: Alternative Approaches to the Use of Restraints •Prevention of Falls and Fall Injuries in the Older Adult •Risk Assessment and Prevention of Pressure Ulcers HEALTHY WORK ENVIRONMENT (HWE): •Developing and Sustaining Effective Staffing and Workload Practices •Preventing and Managing Violence in the Workplace •Developing and Sustaining Interprofessional Healthcare •Preventing and Mitigating Nurse Fatigue in Health Care •Workplace Health, Safety and Well-Being of the Nurse

50% off select BPGs

until October 31, 2015

SUMMER 2015 BPG Sale!

Best Practices in Long-Term Care

ANNOUNCEMENTS

Welcome to the Team!

Suman Iqbal joined the Long-Term Care (LTC) Best Practices Program as

the best practice co-ordinator for provincial projects. She has a combined

master of science in nursing and master of health administration from the

University of Phoenix and more than 25 years experience. Suman previously

served as professional leader of nursing and manager of clinical informatics

at Sunnybrook Health Sciences Centre. Prior to this, she worked for

Baycrest in progressive management positions in the Apotex Jewish Home

for the Aged, including as the director of nursing and personal care. She has

successfully established, led and sustained positive change through best

practice implementation and quality improvement initiatives including BPSO

pre-designation activities. Suman can be reached via e-mail at

siqbal@RNAO.ca

Freda Poirier joined the team as LTC best practice co-ordinator covering the North East region. Freda holds the Canadian Nurses’ Association specialty certification in gerontological nursing and certification in teaching and training adults from Georgian College. Freda was a director of care for a not-for-profit LTC home and an RAI co-ordinator and charge nurse. She also completed the Advanced Palliative Care Education Program and volunteered as a nurse on several transcultural expeditions to the Dominican Republic. Freda can be reached at fpoirier@RNAO.ca

Thank you Long-Term Care Home

Lead Agencies

RNAO is grateful for the support provided by the long-term care homes that served as lead agencies and contributed to the development of the LTC Best Practices Program. From 2005 to 2015, the lead agency model was used to develop strong linkages within the Local Health Integration Networks (LHIN) and LTCHs across the province. This model served as a foundation for the LTC best practice co-ordinators to expand relationships with LTCH leaders, staff and community partners. As RNAO moves forward in the next phase of the program’s development, we will undertake new approaches, including the LTC Best Practice Spotlight Organization designation, to engage LTCHs in best practice implementation. We thank all of the LTCHs that served as lead agencies and their contribution to the dissemination and uptake of evidence-based practices and best practice guidelines. We look forward to continuing to work with you.

RNAO’s Long-Term Care Best Practices Program Newsletter Editors: Carol Holmes, Suman Iqbal, Heather McConnell and Daniel Punch.

Newsletter Designed by: Verity White

Please send comments/inquiries by email to LTCBPP@RNAO.ca.

This program is made possible

through funding by the Government of Ontario.

www.RNAO.ca/ltc | p9